Healthcare Provider Details

I. General information

NPI: 1477161057
Provider Name (Legal Business Name): LAMANCIA WILLIAMS LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGTREE DR STE 200
COLUMBIA SC
29223-8614
US

IV. Provider business mailing address

2121 HERTFORD DR
COLUMBIA SC
29210-6127
US

V. Phone/Fax

Practice location:
  • Phone: 803-722-4975
  • Fax:
Mailing address:
  • Phone: 803-422-5305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: